Updated Guidelines for Buprenorphine Treatment for Opioid Use Disorder
Buprenorphine is an effective agonist treatment for opioid use disorder, but guidelines for its administration have not been updated in over a decade, despite new research and practice experience. Researchers convened a 10-member panel of experts in addiction medicine and primary care to review existing buprenorphine treatment guidelines. Using a modified RAND/UCLA Appropriateness Method, the panel rated specific guideline statements on a scale ranging from 1 (definitely not valid) to 9 (definitely valid) over 2 rounds of rating, with an inter-round 4-hour discussion session via webinar.
- Of 90 existing guideline statements across 8 domains (candidate assessment, selection, treatment contract, dosing, monitoring, discontinuation, psychosocial counseling, and treatment of co-occurring mood disorders), panelists rated 65 (72%) as valid (scores 7–9 and without disagreement among panelists).
- Nineteen guideline statements were reworded and 6 new guideline statements written during the discussion session.
- Domains with high consensus among panelists were: type of assessments before initiation, use of treatment contracts, and treatment of co-occurring mood disorders.
- Domains with lower consensus were dosing (e.g., setting a maximum dose), monitoring, and duration of treatment.
Comments:
The panel provided the valuable service of updating and distilling buprenorphine treatment guidelines to reflect current practice and prescribers should find them very useful. However, it is not clear if the updated guidelines will actually increase credentialed physicians’ comfort in prescribing buprenorphine, particularly if existing discomfort centers around the domains (dosing, monitoring, duration) where consensus was low among the expert panel.
Kevin L. Kraemer, MD, MSc
Reference:
Farmer CM, Lindsay D, Williams J, et al. Practice guidance for buprenorphine for the treatment of opioid use disorders: results of an expert panel process. Subst Abuse. 2015;6:1–8.